EP3469999A1 - Debrider warning system - Google Patents
Debrider warning system Download PDFInfo
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- EP3469999A1 EP3469999A1 EP18199917.8A EP18199917A EP3469999A1 EP 3469999 A1 EP3469999 A1 EP 3469999A1 EP 18199917 A EP18199917 A EP 18199917A EP 3469999 A1 EP3469999 A1 EP 3469999A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
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- A—HUMAN NECESSITIES
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- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
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- A61B17/3209—Incision instruments
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- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
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- A—HUMAN NECESSITIES
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Definitions
- the present invention relates generally to medical probes, and specifically to an invasive medical probe comprising a cutting end.
- Some medical probes include cutting blades (also known as cutting ends) that can be used to remove tissue during an invasive medical procedure. These medical probes typically include position sensors that can be used to keep track of the current location and orientation of the cutting blade.
- U.S. Patent 7,720,521 to Chang et al. describes a device for performing procedures within an ear, nose, throat and a paranasal sinus.
- the device includes a sensor that can be used to determine a location of a treatment device (e.g., a needle, a debrider or a cutter) affixed to the device.
- a treatment device e.g., a needle, a debrider or a cutter
- U.S. Patent 7,559,925 to Goldfarb et al. describes devices for facilitating visualization in a surgical environment.
- the devices include a fluoroscope, a first introducing device (e.g., a sinus guide, a guide catheter or a guide tube) that can be introduced under direct visualization (i.e., by the fluoroscope), a second introducing device (e.g., a guidewire or an elongated probe) and a working device (e.g., a balloon catheter, a dilatation catheter, a debrider, or a cutter).
- a fluoroscope e.g., a sinus guide, a guide catheter or a guide tube
- a second introducing device e.g., a guidewire or an elongated probe
- a working device e.g., a balloon catheter, a dilatation catheter, a debrider, or a cutter.
- U.S. Patent Application 2005/0054900 to Mawn et al. describes an ophthalmic orbital surgery apparatus and image-guided navigation system.
- the apparatus and system includes a flexible endoscope, a rigid endoscope having a magnetic tracking tip, and a magnetic tracking system configured to detect the magnetic tracking tip in three dimensional space, and to communicate the magnetic tracking tip location data to the apparatus for collecting and processing physical space data.
- a medical apparatus including an insertion tube having a proximal end, and a distal end for insertion into a body cavity including one or more anatomical structures.
- the medical apparatus also includes a cutting blade mounted at the distal end of the insertion tube, a handle affixed to the proximal end and including a warning device which generates different sensible outputs in response to receiving different activation signals, and a position sensor fixed in a predefined disposition relative to the insertion tube.
- the medical apparatus additionally includes a processor configured to acquire, from an imaging system, a three-dimensional (3D) image of the body cavity, to determine, in the 3D image, respective 3D structure locations for each of the one or more anatomical structures, to receive, from the position sensor, a position signal indicative of a 3D blade location of the cutting blade within the body cavity, to determine, based on the 3D blade location and the respective 3D structure locations, a proximity of the cutting blade to a given anatomical structure, and to convey, to the warning device, a given activation signal in response to the determined proximity to the given anatomical structure.
- a processor configured to acquire, from an imaging system, a three-dimensional (3D) image of the body cavity, to determine, in the 3D image, respective 3D structure locations for each of the one or more anatomical structures, to receive, from the position sensor, a position signal indicative of a 3D blade location of the cutting blade within the body cavity, to determine, based on the 3D blade location and the respective 3D structure locations, a
- the warning device is detachable from the handle.
- the warning device includes an illumination device or an audio generating device.
- the sensible output generated by the illumination device in response to the determined proximity to the given anatomical structure includes light having different colors, different intensities, or different durations.
- the sensible output generated by the audio generating device in response to the determined proximity to the given anatomical structure includes sounds having different tones, different frequencies, different volumes, different durations, different rates of recurrence or different synthesized words.
- the medical apparatus may include a display, and the processor may be configured to present, on the display, the sensible output in response to the determined proximity to the given anatomical structure.
- the position sensor includes a triaxial coil.
- the imaging system includes a computed tomography scanner.
- the imaging system includes an image coordinate system
- the position sensor includes a sensor coordinate system
- the processor prior to receiving the position signal indicative of a 3D blade location of the cutting blade within the body cavity, the processor is configured to register the sensor coordinate system to the image coordinate system.
- the medical apparatus includes a motor mounted within the handle and configured to rotate the cutting blade at a plurality of rotation speeds, and wherein the processor is configured to reduce the rotation speed of the cutting blade as the cutting blade approaches a given anatomical structure.
- the anatomical structures in the 3D image include different tissue radiodensities
- the processor is configured to determine a given 3D structure location by detecting the different radiodensities in the 3D image, segmenting, based on the detected different radiodensities, the 3D image into multiple segments, and determining respective 3D locations of the segments.
- the processor is configured to formulate an identification of a given segment of the multiple segments, and wherein the activation signal includes the identification.
- a method including acquiring, from an imaging system, a three-dimensional (3D) image of a body cavity including one or more anatomical structures, determining, in the 3D image, respective 3D structure locations for each of the one or more anatomical structures, receiving, from a medical probe having an insertion tube and a position sensor fixed in a predefined disposition relative to the insertion tube, a position signal indicative of a 3D location of a cutting blade mounted at a distal end of the insertion tube and inserted into the body cavity, determining, by a processor based on the 3D blade location and the respective 3D structure locations, a proximity of the cutting blade to a given anatomical structure, conveying, to a warning device mounted on a handle affixed to a proximal end of the insertion tube and configured to generate different sensible outputs in response to receiving different activation signals, a given activation signal in response to the determined proximity to the given anatomical structure, receiving, by the
- a computer software product operated in conjunction with a medical probe having an insertion tube and a position sensor fixed in a predefined disposition relative to the insertion tube
- the product including a non-transitory computer-readable medium, in which program instructions are stored, which instructions, when read by a computer, cause the computer to acquire, from an imaging system, a three-dimensional (3D) image of a body cavity including one or more anatomical structures, to determine, in the 3D image, respective 3D structure locations for each of the one or more anatomical structures, to receive, from the position sensor, a position signal indicative of a 3D location of a cutting blade mounted at a distal end of the insertion tube and inserted into the body cavity, to determine, based on the 3D blade location and the respective 3D structure locations, a proximity of the cutting blade to a given anatomical structure, and to convey, to a warning device mounted on a handle affixed to a proximal end of the insertion
- Invasive medical probes such as debriders may comprise cutting ends (e.g., a blade) that, during a medical procedure, may closely approach sensitive regions in a patient. Examples of sensitive regions include an eye, an optic nerve, the carotid artery, and the brain. Therefore, it is important to notify an operating physician when a cutting end of a medical probe approaches a given sensitive region.
- One method for tracking the cutting end is to use fluoroscopy, but because of its ionizing characteristic, the use of fluoroscopy should be minimized.
- an apparatus in embodiments of the present invention, includes a medical probe (e.g., a debrider) that can be used to perform invasive medical procedures on a patient.
- the medical probe comprises an insertion tube comprising a proximal end, and a distal end for insertion into a body cavity having one or more anatomical structures.
- the medical probe also comprises a cutting blade mounted at the distal end of the insertion tube, and a handle affixed to the proximal end.
- the medical probe additionally comprises a warning device which generates different sensible outputs in response to receiving different activation signals, and a position sensor fixed in a predefined disposition relative to the insertion tube.
- the apparatus also includes a processor configured to acquire, from an imaging system, a three-dimensional (3D) image of the body cavity, and to determine, in the 3D image, respective 3D structure locations for each of the one or more anatomical structures.
- the processor is further configured to receive, from the position sensor, a position signal indicative of a 3D blade location of the cutting blade within the body cavity, and to determine, based on the 3D blade location and the respective 3D structure locations, a proximity of the cutting blade to a given anatomical structure.
- the processor Upon determining that the cutting blade is in proximity to a given anatomical structure, the processor is configured to convey, to the warning device, a given activation signal in response to the determined proximity to the given anatomical structure, and the warning device is configured to generate a given sensible output upon receiving the given activation signal.
- the given sensible output may comprise a visual and/or an audial notification.
- the warning device can generate different sensible outputs for different distances between the cutting blade and the different anatomical structures. Therefore, medical systems implementing embodiments of the present invention can help prevent accidental damage to sensitive anatomical structures (e.g., arteries and nerves) during invasive medical procedures.
- sensitive anatomical structures e.g., arteries and nerves
- FIGS 1A and 1B are schematic pictorial illustrations of a medical system 20 comprising a medical probe 22 configured to generate location-based warnings, in accordance with an embodiment of the present invention.
- medical system 20 comprises a medical imaging system comprising a computed tomography (CT) scanner 24, a control console 26, and medical probe 22.
- CT computed tomography
- medical probe 22 is used for diagnostic or therapeutic treatment, such as minimally invasive catheter-based sinus surgery on a patient 28.
- medical probe 22 may be used, mutatis mutandis, for other therapeutic and/or diagnostic purposes.
- computed tomography scanner 24 Prior to performing an invasive medical procedure on patient 28, computed tomography scanner 24 generates electrical signals comprising image data for a lumen (e.g., a nasal cavity or a paranasal sinus) of the patient, and conveys the generated image data to control console 26.
- Computed tomography scanner 24 generates the image data in an image coordinate system 30 comprising an X-axis 32, a Y-axis 34 and a Z-axis 36.
- medical probe 22 comprises a handle 38 that an operator 40 can grasp and manipulate in order to insert a distal end 42 of the medical probe into a lumen, such as a nasal cavity or a paranasal sinus, of patient 28.
- control console 26 comprises a processor 44 that converts the received image data into an image 46, and presents the image as information regarding the medical procedure on a display 48.
- Display 48 is assumed, by way of example, to comprise a flat panel display such as a liquid crystal display, a light emitting diode display, an organic light-emitting diode display or a plasma display. However, other display devices can also be employed to implement embodiments of the present invention. In some embodiments, display 48 may comprise a touchscreen that can be configured to accept inputs from operator 40, in addition to presenting image 46.
- a flat panel display such as a liquid crystal display, a light emitting diode display, an organic light-emitting diode display or a plasma display.
- display 48 may comprise a touchscreen that can be configured to accept inputs from operator 40, in addition to presenting image 46.
- control console 26 drives display 48 to update image 46 in order to present a current position of distal end 42 in the patient's body, as well as status information and guidance regarding the medical procedure that is in progress.
- Processor 44 stores data representing image 46 in a memory 50.
- operator 40 can manipulate image 46 using one or more input devices 52.
- display 48 comprises a touchscreen display
- operator 40 can manipulate image 46 via the touchscreen display.
- Processor 44 typically comprises a general-purpose computer, with suitable front end and interface circuits for receiving signals from medical probe 22 and controlling the other components of control console 26.
- Processor 44 may be programmed in software to carry out the functions that are described herein.
- the software may be downloaded to control console 26 in electronic form, over a network, for example, or it may be provided on non-transitory tangible media, such as optical, magnetic or electronic memory media.
- some or all of the functions of processor 44 may be carried out by dedicated or programmable digital hardware components.
- medical system 20 uses magnetic position sensing to determine position coordinates (i.e., a location and an orientation) of distal end 42 of medical probe 22 inside patient 28.
- control console 26 comprises a driver circuit 54 which drives field generators 56 to generate magnetic fields within the body of patient 26.
- field generators 56 comprise three orthogonally oriented coils, which are placed below the patient at known positions external to patient 28. These coils generate magnetic fields in a predefined working volume that contains a lumen such as a paranasal sinus.
- a magnetic field sensor 58 (typically a triaxial coil, also referred to herein as position sensor 58) fixed within handle 38 of medical probe 22 generates electrical signals in response to the magnetic fields from the generator coils, thereby enabling processor 44 to determine the position of distal end 42 within a lumen in patient 28, since there is a known displacement between sensor 58 and distal end 42.
- the position of sensor 58, and thus of distal end 42, is determined with respect to a frame of reference 60, also referred to herein as sensor coordinate system 60, defined by field generators 56.
- the field from generators 56 is calibrated, prior to positioning patient 28 in the field.
- the calibration typically comprises processor 44 acquiring calibration signals from a calibration sensor such as sensor 28, while the calibration sensor is positioned at known, measured, locations relative to generators 56. Processor 44 is then able to form a correspondence between the known locations and the calibration signals, and to use the correspondence to determine the location of sensor 58 in system 60 from the signals the sensor generates.
- the signals generated by magnetic field sensor 58 indicate the current location of distal end 42 in a sensor coordinate system 60 comprising an X-axis 62, a Y-axis 64 and a Z-axis 66.
- X-axis 62 generally corresponds to X-axis 32
- Y-axis 64 generally corresponds to Y-axis 34
- Z-axis 66 generally corresponds to Z-axis 36.
- medical probe comprises an outer tube 68 (also referred to herein as an insertion tube) having a proximal end 41 affixed to handle 38, and a distal end 42 comprising a radial cutting window opening 70 in proximity to a distal tip 72 of the outer tube.
- Medical probe 22 also comprises an inner tube 74 that is positioned within outer tube 68 and comprises a cutting blade 76 (also known as a cutting end, since it is positioned at distal end 42). In operation, as cutting blade 76 traverses radial cutting window opening 70, the cutting blade can remove any body tissue protruding into the cutting window.
- Handle 38 also comprises a motor 78 that rotates inner tube 74 within outer tube 68, thereby enabling cutting blade 76 to traverse radial cutting window opening 70.
- position sensor 58 is affixed to handle 38 in a predefined disposition relative to insertion tube 68 and cutting blade 76.
- position sensor 58 can be affixed to insertion tube 68 in a predefined disposition relative to cutting blade 76.
- handle 38 also comprises a warning device 80, and an input/output (I/O) communications interface 82 that enables the control console to transfer signals from, and/or transfer signals to driver circuit 54, position sensor 58, motor 78, and warning device 80.
- Driver circuit 54, position sensor 58, motor 78 and warning device 80 are all coupled to I/O interface 82 in control console 26 via wired connections (not shown) and/or wireless connections, thereby enabling the control console to (a) receive position signals from position sensor 58, (b) control the speed of motor 78, and (c) convey an activation signal to warning device 80.
- Warning device 80 generates sensible outputs and comprises one or more illumination devices (e.g., light emitting diodes) that can convey a visual sensible output and/or an audio generating device (e.g., a speaker) that can generate an audible sensible output.
- warning device 80 can convey different types of sensible outputs in response to different activation signals.
- the different types of sensible outputs may include different colors (e.g., green, yellow and blue), different intensities, different durations and different rates of recurrence (i.e., blinking).
- warning device 80 comprises a speaker
- the different types of sensible outputs may include sounds having different tones/frequencies, different volumes, different durations, different rates of recurrence (i.e., beeping) and synthesized words (e.g., "Warning").
- warning device 80 may be removably attached (i.e., detachable) from handle 38.
- Figure 2 is a flow diagram that schematically illustrates a method of generating, by medical probe 22, a sensible output when cutting blade 76 is in proximity to a sensitive region in patient 28
- Figure 3 is a schematic detail view showing distal end 42 inserted into a sinus cavity 110 of the patient
- Figure 4 is a schematic pictorial illustration showing an image slice 120 of a three-dimensional computed tomography image that processor 44 generates in response to receiving image data from computed tomography scanner 23, in accordance with embodiments of the present invention.
- patient 28 has multiple anatomical structures 112, and in embodiments of the present invention, the sensitive region comprises a given anatomical structure 112, such as an eye, a nerve (e.g., an optic nerve), or an artery (e.g., the carotid artery).
- a nerve e.g., an optic nerve
- an artery e.g., the carotid artery
- processor 44 acquires three-dimensional (3D) image data from computed tomography scanner 24, stores the image data to memory 50, and generates, based on the acquired image data, a three-dimensional image. While embodiments herein describe acquiring the 3D image data from computed tomography scanner 24, acquiring the 3D image data from any other type of medical imaging system is considered to be within the spirit and scope of the present invention.
- processor 44 segments the received 3D image into multiple segments 122, and determines respective 3D locations of the segments.
- each segment 122 may comprise at least one anatomical structure 112.
- processor 44 can present image slice 120 as image 46 on display 48, and operator 40 can use input devices 52 to manually delineate the image slice (i.e., the 3D image) into segments 122.
- a given sensitive region may comprise one or more segments 122.
- the 3D image of patient 28 produced by CT scanner 24 typically comprises different gray scales to represent different tissue radiodensities (e.g., for bone tissue, nerve tissue and brain tissue) in the patient.
- processor 44 can first detect a recognizable feature of a given anatomical structure 112 in patient 28, and then analyze radiodensities of tissue in proximity to the identified feature. For example, to segment an eye and an optic nerve in the received 3D image, processor 44 can:
- operator 40 can manually segment the received 3D image by:
- Steps 90 and 92 are typically performed prior to a medical procedure to be performed on patient 28.
- operator 40 manipulates handle 38 so that, in an insertion step 94, distal end 42 enters a body cavity in patient 28.
- processor 44 registers image coordinate system 30 to sensor coordinate system 60, and in a receiving step 98, the processor receives signals from magnetic field sensor 58 indicating a location of cutting blade 76 in the body cavity.
- processor 44 can compute, based on the received signals, a location of position sensor 58, and add a vector (determined by a previously performed calibration) to the computed location to determine the location of cutting blade 76.
- processor 44 can also determine an orientation of cutting blade 76.
- processor 44 can present image 46 on display 48, and operator 40 can manipulate handle 38 so that distal tip 72 engages an identifiable feature of patient 28 (e.g., an ostium sinus coronary, also known as an orifice of coronary sinus or simply "OS") that is in the image and has an image location in image coordinate system 30.
- an identifiable feature of patient 28 e.g., an ostium sinus coronary, also known as an orifice of coronary sinus or simply "OS”
- OS orifice of coronary sinus or simply "OS”
- processor 44 can determine, based on signals received from position sensor 58, a magnetic location of the distal tip in sensor coordinate system 60.
- Processor 44 can compute, based on the magnetic and the image locations, a registration vector that can be used to register image coordinate system 30 to sensor coordinate system 60.
- processor 44 is configured to convey different activation signals to warning device 80, and the warning device is configured to generate different types of visual and or audio sensible outputs in response to the conveyed activation signal.
- processor 44 can convey a given activation signal to warning device 80, and upon receiving the given activation signal, the warning device can generate a given sensible output in a generation step 102.
- the activation signals and the sensible outputs are responsive to the given sensitive region and the location of cutting blade 76 within the given sensitive region.
- processor 44 can convey different activation signals to warning device 80 based on (a) a given anatomical structure in proximity to cutting blade 76, and (b) a distance between the cutting blade and the given anatomical structure.
- the anatomical structures comprise blood vessels and nerves
- processor 44 can assign a high importance level to arteries (e.g., the carotid artery), a medium importance level to nerves (e.g., an optic nerve), and a low importance level to empty space in the body cavity, and convey different activation signals based on the respective importance levels.
- arteries e.g., the carotid artery
- medium importance level to nerves e.g., an optic nerve
- a low importance level to empty space in the body cavity
- the LED can be configured to:
- warning device 80 comprises an audio generating device (i.e., circuitry and a speaker) that can generate audio output comprising synthesized speech that identifies a given anatomical structure 112 (e.g., "optic nerve")_and a distance between blade 76 and the given anatomical structure (e.g., "five millimeters").
- warning device 80 may comprise a probe display (e.g., an LED screen) mounted on the handle, and processor 44 can present the given anatomical structure and the distance on the probe display (e.g., "Brain 5mm").
- warning device 80 can be configured to convey additional sensible outputs indicating a distance to a given anatomical structure 112.
- warning device 80 comprises an LED
- the LED can blink faster if the received the activation signal indicates that the cutting blade is moving closer to the given anatomical structure, and blink slower if the received the activation signal indicates that the cutting blade is moving away from the given anatomical structure.
- the different sensible outputs may also comprise different sounds.
- processor 44 can present the given sensible output on display 48.
- processor 44 can present, on the display, a message (e.g., an icon representing a given anatomical structure 112) with different visual effects (e.g., colors, intensity, size or blinking frequency) to indicate the current distance between the cutting blade and a given anatomical structure 112.
- the message on display 48 may also include text identifying a given anatomical structure 112 and a distance between the cutting blade and the given anatomical structure 112 (e.g., "Brain 5mm").
- processor 44 can adjust a speed of motor 78 (and therefore the rotation speed of cutting blade 76) based on the distance between the cutting blade and a given anatomical structure 112. For example, processor 44 can reduce the speed of the motor as the cutting blade approaches a given anatomical structure (e.g., an artery or a nerve as described supra). In some embodiments, processor 44 can turn off motor 78 when cutting blade is very close (e.g., 2 mm) to an anatomical structure such as the carotid artery or an eye. In other words, processor 44 can control motor 78 so that the speed of the motor is directly related to the distance between cutting blade 76 and a given anatomical structure 112 (i.e., higher speeds at greater distances and lower speeds at smaller distances).
- step 104 if the medical procedure is complete, then the method ends. If the medical procedure is not complete, then the method continues with step 98. Returning to step 100, if the location of cutting blade 76 is not within a given sensitive region, then the method continues with step 104.
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Abstract
Description
- The present invention relates generally to medical probes, and specifically to an invasive medical probe comprising a cutting end.
- Some medical probes (e.g., debriders) include cutting blades (also known as cutting ends) that can be used to remove tissue during an invasive medical procedure. These medical probes typically include position sensors that can be used to keep track of the current location and orientation of the cutting blade.
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U.S. Patent 7,720,521 to Chang et al. , describes a device for performing procedures within an ear, nose, throat and a paranasal sinus. The device includes a sensor that can be used to determine a location of a treatment device (e.g., a needle, a debrider or a cutter) affixed to the device. -
U.S. Patent Application 2008/0118725 to Lloyd , describes a system for visual verification of computed tomography (CT) registration and feedback. The system is configured to track different types of surgical devices inside a patient during a medical procedure. -
U.S. Patent 7,559,925 to Goldfarb et al. , describes devices for facilitating visualization in a surgical environment. The devices include a fluoroscope, a first introducing device (e.g., a sinus guide, a guide catheter or a guide tube) that can be introduced under direct visualization (i.e., by the fluoroscope), a second introducing device (e.g., a guidewire or an elongated probe) and a working device (e.g., a balloon catheter, a dilatation catheter, a debrider, or a cutter). -
U.S. Patent Application 2005/0054900 to Mawn et al. , describes an ophthalmic orbital surgery apparatus and image-guided navigation system. The apparatus and system includes a flexible endoscope, a rigid endoscope having a magnetic tracking tip, and a magnetic tracking system configured to detect the magnetic tracking tip in three dimensional space, and to communicate the magnetic tracking tip location data to the apparatus for collecting and processing physical space data. - The description above is presented as a general overview of related art in this field and should not be construed as an admission that any of the information it contains constitutes prior art against the present patent application.
- Documents incorporated by reference in the present patent application are to be considered an integral part of the application except that to the extent any terms are defined in these incorporated documents in a manner that conflicts with the definitions made explicitly or implicitly in the present specification, only the definitions in the present specification should be considered.
- There is provided, in accordance with an embodiment of the present invention, a medical apparatus, including an insertion tube having a proximal end, and a distal end for insertion into a body cavity including one or more anatomical structures. The medical apparatus also includes a cutting blade mounted at the distal end of the insertion tube, a handle affixed to the proximal end and including a warning device which generates different sensible outputs in response to receiving different activation signals, and a position sensor fixed in a predefined disposition relative to the insertion tube. The medical apparatus additionally includes a processor configured to acquire, from an imaging system, a three-dimensional (3D) image of the body cavity, to determine, in the 3D image, respective 3D structure locations for each of the one or more anatomical structures, to receive, from the position sensor, a position signal indicative of a 3D blade location of the cutting blade within the body cavity, to determine, based on the 3D blade location and the respective 3D structure locations, a proximity of the cutting blade to a given anatomical structure, and to convey, to the warning device, a given activation signal in response to the determined proximity to the given anatomical structure.
- In some embodiments, the warning device is detachable from the handle. In additional embodiments, the warning device includes an illumination device or an audio generating device. In embodiments where the warning device includes an illumination device, the sensible output generated by the illumination device in response to the determined proximity to the given anatomical structure includes light having different colors, different intensities, or different durations. In embodiments where the warning device includes an audio generating device, the sensible output generated by the audio generating device in response to the determined proximity to the given anatomical structure includes sounds having different tones, different frequencies, different volumes, different durations, different rates of recurrence or different synthesized words.
- The medical apparatus may include a display, and the processor may be configured to present, on the display, the sensible output in response to the determined proximity to the given anatomical structure. In further embodiments, the position sensor includes a triaxial coil. In supplemental embodiments, the imaging system includes a computed tomography scanner.
- In some embodiments, the imaging system includes an image coordinate system, wherein the position sensor includes a sensor coordinate system, and wherein prior to receiving the position signal indicative of a 3D blade location of the cutting blade within the body cavity, the processor is configured to register the sensor coordinate system to the image coordinate system. In additional embodiments, the medical apparatus includes a motor mounted within the handle and configured to rotate the cutting blade at a plurality of rotation speeds, and wherein the processor is configured to reduce the rotation speed of the cutting blade as the cutting blade approaches a given anatomical structure.
- In further embodiments, the anatomical structures in the 3D image include different tissue radiodensities, and wherein the processor is configured to determine a given 3D structure location by detecting the different radiodensities in the 3D image, segmenting, based on the detected different radiodensities, the 3D image into multiple segments, and determining respective 3D locations of the segments. In one embodiment, the processor is configured to formulate an identification of a given segment of the multiple segments, and wherein the activation signal includes the identification.
- There is also provided, in accordance with an embodiment of the present invention, a method, including acquiring, from an imaging system, a three-dimensional (3D) image of a body cavity including one or more anatomical structures, determining, in the 3D image, respective 3D structure locations for each of the one or more anatomical structures, receiving, from a medical probe having an insertion tube and a position sensor fixed in a predefined disposition relative to the insertion tube, a position signal indicative of a 3D location of a cutting blade mounted at a distal end of the insertion tube and inserted into the body cavity, determining, by a processor based on the 3D blade location and the respective 3D structure locations, a proximity of the cutting blade to a given anatomical structure, conveying, to a warning device mounted on a handle affixed to a proximal end of the insertion tube and configured to generate different sensible outputs in response to receiving different activation signals, a given activation signal in response to the determined proximity to the given anatomical structure, receiving, by the warning device, the given activation signal, and generating, by the warning device, a given sensible output in response to the received activation signal.
- There is additionally provided, in accordance with an embodiment of the present invention, a computer software product, operated in conjunction with a medical probe having an insertion tube and a position sensor fixed in a predefined disposition relative to the insertion tube, the product including a non-transitory computer-readable medium, in which program instructions are stored, which instructions, when read by a computer, cause the computer to acquire, from an imaging system, a three-dimensional (3D) image of a body cavity including one or more anatomical structures, to determine, in the 3D image, respective 3D structure locations for each of the one or more anatomical structures, to receive, from the position sensor, a position signal indicative of a 3D location of a cutting blade mounted at a distal end of the insertion tube and inserted into the body cavity, to determine, based on the 3D blade location and the respective 3D structure locations, a proximity of the cutting blade to a given anatomical structure, and to convey, to a warning device mounted on a handle affixed to a proximal end of the insertion tube and configured to generate a plurality of sensible outputs in response to receiving a corresponding plurality of activation signals, a given activation signal in response to the determined proximity to the given anatomical structure.
- The disclosure is herein described, by way of example only, with reference to the accompanying drawings, wherein:
-
Figures 1A and1B , referred to collectively asFigure 1 , are schematic pictorial illustrations of a medical system comprising a medical probe having a location-based warning module, in accordance with an embodiment of the present invention; -
Figure 2 is a flow diagram that schematically illustrates a method of generating, by the medical probe, a sensible output when a cutting blade on the medical probe is in proximity to a sensitive region in a patient, in accordance with an embodiment of the present invention; -
Figure 3 is a schematic detail view showing a distal end of the medical probe inserted into a sinus cavity of the patient, in accordance with an embodiment of the present invention; and -
Figure 4 is a schematic pictorial illustration showing an image slice of a three-dimensional computed tomography (CT) image of the patient generated in response to receiving image data from a CT scanner, in accordance with an embodiment of the present invention. - Invasive medical probes such as debriders may comprise cutting ends (e.g., a blade) that, during a medical procedure, may closely approach sensitive regions in a patient. Examples of sensitive regions include an eye, an optic nerve, the carotid artery, and the brain. Therefore, it is important to notify an operating physician when a cutting end of a medical probe approaches a given sensitive region. One method for tracking the cutting end is to use fluoroscopy, but because of its ionizing characteristic, the use of fluoroscopy should be minimized.
- In embodiments of the present invention, an apparatus includes a medical probe (e.g., a debrider) that can be used to perform invasive medical procedures on a patient. The medical probe comprises an insertion tube comprising a proximal end, and a distal end for insertion into a body cavity having one or more anatomical structures. The medical probe also comprises a cutting blade mounted at the distal end of the insertion tube, and a handle affixed to the proximal end. The medical probe additionally comprises a warning device which generates different sensible outputs in response to receiving different activation signals, and a position sensor fixed in a predefined disposition relative to the insertion tube.
- The apparatus also includes a processor configured to acquire, from an imaging system, a three-dimensional (3D) image of the body cavity, and to determine, in the 3D image, respective 3D structure locations for each of the one or more anatomical structures. The processor is further configured to receive, from the position sensor, a position signal indicative of a 3D blade location of the cutting blade within the body cavity, and to determine, based on the 3D blade location and the respective 3D structure locations, a proximity of the cutting blade to a given anatomical structure.
- Upon determining that the cutting blade is in proximity to a given anatomical structure, the processor is configured to convey, to the warning device, a given activation signal in response to the determined proximity to the given anatomical structure, and the warning device is configured to generate a given sensible output upon receiving the given activation signal. The given sensible output may comprise a visual and/or an audial notification.
- In embodiments described herein, the warning device can generate different sensible outputs for different distances between the cutting blade and the different anatomical structures. Therefore, medical systems implementing embodiments of the present invention can help prevent accidental damage to sensitive anatomical structures (e.g., arteries and nerves) during invasive medical procedures.
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Figures 1A and1B , referred to collectively asFigure 1 , are schematic pictorial illustrations of amedical system 20 comprising amedical probe 22 configured to generate location-based warnings, in accordance with an embodiment of the present invention. In the example shown inFigure 1A ,medical system 20 comprises a medical imaging system comprising a computed tomography (CT)scanner 24, acontrol console 26, andmedical probe 22. In embodiments described herein, it is assumed thatmedical probe 22 is used for diagnostic or therapeutic treatment, such as minimally invasive catheter-based sinus surgery on apatient 28. Alternatively,medical probe 22 may be used, mutatis mutandis, for other therapeutic and/or diagnostic purposes. - Prior to performing an invasive medical procedure on
patient 28, computedtomography scanner 24 generates electrical signals comprising image data for a lumen (e.g., a nasal cavity or a paranasal sinus) of the patient, and conveys the generated image data to controlconsole 26. Computedtomography scanner 24 generates the image data in animage coordinate system 30 comprising anX-axis 32, a Y-axis 34 and a Z-axis 36. - As shown in
Figure 1B ,medical probe 22 comprises ahandle 38 that anoperator 40 can grasp and manipulate in order to insert adistal end 42 of the medical probe into a lumen, such as a nasal cavity or a paranasal sinus, ofpatient 28. In the configuration shown inFigure 1 ,control console 26 comprises aprocessor 44 that converts the received image data into animage 46, and presents the image as information regarding the medical procedure on adisplay 48. -
Display 48 is assumed, by way of example, to comprise a flat panel display such as a liquid crystal display, a light emitting diode display, an organic light-emitting diode display or a plasma display. However, other display devices can also be employed to implement embodiments of the present invention. In some embodiments,display 48 may comprise a touchscreen that can be configured to accept inputs fromoperator 40, in addition to presentingimage 46. - Based on the signals received from
medical probe 22 and other components ofmedical system 20,control console 26 drives display 48 to updateimage 46 in order to present a current position ofdistal end 42 in the patient's body, as well as status information and guidance regarding the medical procedure that is in progress.Processor 44 storesdata representing image 46 in amemory 50. In some embodiments,operator 40 can manipulateimage 46 using one ormore input devices 52. In embodiments wheredisplay 48 comprises a touchscreen display,operator 40 can manipulateimage 46 via the touchscreen display. -
Processor 44 typically comprises a general-purpose computer, with suitable front end and interface circuits for receiving signals frommedical probe 22 and controlling the other components ofcontrol console 26.Processor 44 may be programmed in software to carry out the functions that are described herein. The software may be downloaded to controlconsole 26 in electronic form, over a network, for example, or it may be provided on non-transitory tangible media, such as optical, magnetic or electronic memory media. Alternatively, some or all of the functions ofprocessor 44 may be carried out by dedicated or programmable digital hardware components. - In embodiments described herein,
medical system 20 uses magnetic position sensing to determine position coordinates (i.e., a location and an orientation) ofdistal end 42 ofmedical probe 22 insidepatient 28. To implement magnetic based position sensing,control console 26 comprises adriver circuit 54 which drivesfield generators 56 to generate magnetic fields within the body ofpatient 26. Typically,field generators 56 comprise three orthogonally oriented coils, which are placed below the patient at known positions external topatient 28. These coils generate magnetic fields in a predefined working volume that contains a lumen such as a paranasal sinus. A magnetic field sensor 58 (typically a triaxial coil, also referred to herein as position sensor 58) fixed withinhandle 38 ofmedical probe 22 generates electrical signals in response to the magnetic fields from the generator coils, thereby enablingprocessor 44 to determine the position ofdistal end 42 within a lumen inpatient 28, since there is a known displacement betweensensor 58 anddistal end 42. - The position of
sensor 58, and thus ofdistal end 42, is determined with respect to a frame of reference 60, also referred to herein as sensor coordinate system 60, defined byfield generators 56. In order to find the correspondence between the signals generated insensor 58 and the position of the sensor, the field fromgenerators 56 is calibrated, prior to positioningpatient 28 in the field. The calibration typically comprisesprocessor 44 acquiring calibration signals from a calibration sensor such assensor 28, while the calibration sensor is positioned at known, measured, locations relative togenerators 56.Processor 44 is then able to form a correspondence between the known locations and the calibration signals, and to use the correspondence to determine the location ofsensor 58 in system 60 from the signals the sensor generates. - Additional magnetic position tracking techniques are described, for example, in
U.S. Patents 5,391,199 ,6,690,963 ,5,443,489 ,6,788,967 ,5,558,091 ,6,172,499 and6,177,792 , whose disclosures are incorporated herein by reference. The signals generated bymagnetic field sensor 58 indicate the current location ofdistal end 42 in a sensor coordinate system 60 comprising anX-axis 62, a Y-axis 64 and a Z-axis 66. In the example shown inFigure 1 ,X-axis 62 generally corresponds to X-axis 32, Y-axis 64 generally corresponds to Y-axis 34 and Z-axis 66 generally corresponds to Z-axis 36. - In the example shown in
Figure 1B , medical probe comprises an outer tube 68 (also referred to herein as an insertion tube) having aproximal end 41 affixed to handle 38, and adistal end 42 comprising a radial cutting window opening 70 in proximity to a distal tip 72 of the outer tube.Medical probe 22 also comprises aninner tube 74 that is positioned within outer tube 68 and comprises a cutting blade 76 (also known as a cutting end, since it is positioned at distal end 42). In operation, as cuttingblade 76 traverses radial cuttingwindow opening 70, the cutting blade can remove any body tissue protruding into the cutting window.Handle 38 also comprises amotor 78 that rotatesinner tube 74 within outer tube 68, thereby enablingcutting blade 76 to traverse radialcutting window opening 70. - In the configuration shown in
Figure 1B ,position sensor 58 is affixed to handle 38 in a predefined disposition relative to insertion tube 68 and cuttingblade 76. In an alternative embodiment,position sensor 58 can be affixed to insertion tube 68 in a predefined disposition relative to cuttingblade 76. - In addition to
position sensor 58 andmotor 78, handle 38 also comprises a warning device 80, and an input/output (I/O)communications interface 82 that enables the control console to transfer signals from, and/or transfer signals todriver circuit 54,position sensor 58,motor 78, and warning device 80.Driver circuit 54,position sensor 58,motor 78 and warning device 80 are all coupled to I/O interface 82 incontrol console 26 via wired connections (not shown) and/or wireless connections, thereby enabling the control console to (a) receive position signals fromposition sensor 58, (b) control the speed ofmotor 78, and (c) convey an activation signal to warning device 80. - Warning device 80 generates sensible outputs and comprises one or more illumination devices (e.g., light emitting diodes) that can convey a visual sensible output and/or an audio generating device (e.g., a speaker) that can generate an audible sensible output. In embodiments of the present invention, warning device 80 can convey different types of sensible outputs in response to different activation signals. In embodiments where warning device 80 comprises one or more illumination devices, the different types of sensible outputs may include different colors (e.g., green, yellow and blue), different intensities, different durations and different rates of recurrence (i.e., blinking). In embodiments where warning device 80 comprises a speaker, the different types of sensible outputs may include sounds having different tones/frequencies, different volumes, different durations, different rates of recurrence (i.e., beeping) and synthesized words (e.g., "Warning"). In some embodiments, warning device 80 may be removably attached (i.e., detachable) from
handle 38. -
Figure 2 is a flow diagram that schematically illustrates a method of generating, bymedical probe 22, a sensible output when cuttingblade 76 is in proximity to a sensitive region inpatient 28,Figure 3 is a schematic detail view showingdistal end 42 inserted into asinus cavity 110 of the patient, andFigure 4 is a schematic pictorial illustration showing animage slice 120 of a three-dimensional computed tomography image thatprocessor 44 generates in response to receiving image data from computed tomography scanner 23, in accordance with embodiments of the present invention. As shown inFigure 3 ,patient 28 has multipleanatomical structures 112, and in embodiments of the present invention, the sensitive region comprises a givenanatomical structure 112, such as an eye, a nerve (e.g., an optic nerve), or an artery (e.g., the carotid artery). - In an
acquisition step 90,processor 44 acquires three-dimensional (3D) image data from computedtomography scanner 24, stores the image data tomemory 50, and generates, based on the acquired image data, a three-dimensional image. While embodiments herein describe acquiring the 3D image data from computedtomography scanner 24, acquiring the 3D image data from any other type of medical imaging system is considered to be within the spirit and scope of the present invention. - In a
segmentation step 92,processor 44 segments the received 3D image intomultiple segments 122, and determines respective 3D locations of the segments. In operation, eachsegment 122 may comprise at least oneanatomical structure 112. In an alternative embodiment,processor 44 can presentimage slice 120 asimage 46 ondisplay 48, andoperator 40 can useinput devices 52 to manually delineate the image slice (i.e., the 3D image) intosegments 122. In some embodiments, a given sensitive region may comprise one ormore segments 122. - The 3D image of
patient 28 produced byCT scanner 24 typically comprises different gray scales to represent different tissue radiodensities (e.g., for bone tissue, nerve tissue and brain tissue) in the patient. To automatically segment the received 3D image intomultiple segments 122,processor 44 can first detect a recognizable feature of a givenanatomical structure 112 inpatient 28, and then analyze radiodensities of tissue in proximity to the identified feature. For example, to segment an eye and an optic nerve in the received 3D image,processor 44 can: - Identify an eye socket by its shape and a first radiodensity indicating bone.
- Identify the eye as a spherical shape in the eye socket having a second radiodensity indicating sclera tissue.
- Identify the optic nerve as tissue extending from the eye having a third radiodensity indicating nerve tissue.
- Segment a first segment comprising the eye socket and eye, and a second segment comprising the optic nerve.
- Alternatively or additionally,
operator 40 can manually segment the received 3D image by: - Identifying a recognizable feature of a given anatomical structure 112 (e.g., the eye socket) in a given
slice 120 of the 3D image presented inimage 46. - Identifying the optic nerve by identifying, in the given slice, tissue having a radiodensity indicating nerve tissue that extends from the eye socket.
- Manipulating input device(s) 52 to delineate and select (i.e., on image 46) a given
segment 122 that includes the identified tissue (i.e., the optic nerve). -
Steps patient 28. To initiate the medical procedure,operator 40 manipulates handle 38 so that, in aninsertion step 94,distal end 42 enters a body cavity inpatient 28. - In a
registration step 96,processor 44 registers image coordinatesystem 30 to sensor coordinate system 60, and in a receivingstep 98, the processor receives signals frommagnetic field sensor 58 indicating a location of cuttingblade 76 in the body cavity. In some embodiments,processor 44 can compute, based on the received signals, a location ofposition sensor 58, and add a vector (determined by a previously performed calibration) to the computed location to determine the location of cuttingblade 76. In some embodiments,processor 44 can also determine an orientation of cuttingblade 76. - To register the coordinate systems,
processor 44 can presentimage 46 ondisplay 48, andoperator 40 can manipulate handle 38 so that distal tip 72 engages an identifiable feature of patient 28 (e.g., an ostium sinus coronary, also known as an orifice of coronary sinus or simply "OS") that is in the image and has an image location in image coordinatesystem 30. When distal tip 72 engages a given identifiable feature (e.g., a given anatomical structure) inimage 46,operator 40 can select the given identifiable feature (e.g., by manipulating a giveninput device 52 to position, on the display, a cursor over the given identifiable feature). Upon receiving the registration signal,processor 44 can determine, based on signals received fromposition sensor 58, a magnetic location of the distal tip in sensor coordinate system 60.Processor 44 can compute, based on the magnetic and the image locations, a registration vector that can be used to register image coordinatesystem 30 to sensor coordinate system 60. - As described hereinbelow,
processor 44 is configured to convey different activation signals to warning device 80, and the warning device is configured to generate different types of visual and or audio sensible outputs in response to the conveyed activation signal. In afirst comparison step 100, if the location of cuttingblade 76 is within a given sensitive region (i.e., the cutting blade is in proximity to a givenanatomical structure 112 in the given sensitive region), thenprocessor 44 can convey a given activation signal to warning device 80, and upon receiving the given activation signal, the warning device can generate a given sensible output in ageneration step 102. - In embodiments of the present invention, the activation signals and the sensible outputs are responsive to the given sensitive region and the location of cutting
blade 76 within the given sensitive region. In other words,processor 44 can convey different activation signals to warning device 80 based on (a) a given anatomical structure in proximity to cuttingblade 76, and (b) a distance between the cutting blade and the given anatomical structure. - In one embodiment, the anatomical structures comprise blood vessels and nerves, and
processor 44 can assign a high importance level to arteries (e.g., the carotid artery), a medium importance level to nerves (e.g., an optic nerve), and a low importance level to empty space in the body cavity, and convey different activation signals based on the respective importance levels. For example, if warning device 80 comprises a light emitting diode (LED), the LED can be configured to: - Emit red light upon receiving a first activation signal indicating that cutting
blade 76 is in proximity to an artery. - Emit yellow light upon receiving a medium importance activation signal indicating that cutting
blade 76 is in proximity to a nerve. - Emit green light upon receiving a low importance activation signal indicating that cutting
blade 76 is not in proximity to any critical anatomical structures 112 (e.g., arteries or nerves). - In another example, warning device 80 comprises an audio generating device (i.e., circuitry and a speaker) that can generate audio output comprising synthesized speech that identifies a given anatomical structure 112 (e.g., "optic nerve")_and a distance between
blade 76 and the given anatomical structure (e.g., "five millimeters"). In a further example, warning device 80 may comprise a probe display (e.g., an LED screen) mounted on the handle, andprocessor 44 can present the given anatomical structure and the distance on the probe display (e.g., "Brain 5mm"). - In some embodiments, warning device 80 can be configured to convey additional sensible outputs indicating a distance to a given
anatomical structure 112. Continuing the example where warning device 80 comprises an LED, the LED can blink faster if the received the activation signal indicates that the cutting blade is moving closer to the given anatomical structure, and blink slower if the received the activation signal indicates that the cutting blade is moving away from the given anatomical structure. As described supra, the different sensible outputs may also comprise different sounds. - Additionally or alternatively,
processor 44 can present the given sensible output ondisplay 48. To present the given sensible output ondisplay 48processor 44 can present, on the display, a message (e.g., an icon representing a given anatomical structure 112) with different visual effects (e.g., colors, intensity, size or blinking frequency) to indicate the current distance between the cutting blade and a givenanatomical structure 112. The message ondisplay 48 may also include text identifying a givenanatomical structure 112 and a distance between the cutting blade and the given anatomical structure 112 (e.g., "Brain 5mm"). - In further embodiments,
processor 44 can adjust a speed of motor 78 (and therefore the rotation speed of cutting blade 76) based on the distance between the cutting blade and a givenanatomical structure 112. For example,processor 44 can reduce the speed of the motor as the cutting blade approaches a given anatomical structure (e.g., an artery or a nerve as described supra). In some embodiments,processor 44 can turn offmotor 78 when cutting blade is very close (e.g., 2 mm) to an anatomical structure such as the carotid artery or an eye. In other words,processor 44 can controlmotor 78 so that the speed of the motor is directly related to the distance betweencutting blade 76 and a given anatomical structure 112 (i.e., higher speeds at greater distances and lower speeds at smaller distances). - Finally, in a
second comparison step 104, if the medical procedure is complete, then the method ends. If the medical procedure is not complete, then the method continues withstep 98. Returning to step 100, if the location of cuttingblade 76 is not within a given sensitive region, then the method continues withstep 104. - It will be appreciated that the embodiments described above are cited by way of example, and that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof which would occur to persons skilled in the art upon reading the foregoing description and which are not disclosed in the prior art.
-
- 1. A method, comprising:
- acquiring, from an imaging system, a three-dimensional (3D) image of a body cavity comprising one or more anatomical structures;
- determining, in the 3D image, respective 3D structure locations for each of the one or more anatomical structures;
- receiving, from a medical probe having an insertion tube and a position sensor fixed in a predefined disposition relative to the insertion tube, a position signal indicative of a 3D location of a cutting blade mounted at a distal end of the insertion tube and inserted into the body cavity;
- determining, by a processor based on the 3D blade location and the respective 3D structure locations, a proximity of the cutting blade to a given anatomical structure;
- conveying, to a warning device mounted on a handle affixed to a proximal end of the insertion tube and configured to generate different sensible outputs in response to receiving different activation signals, a given activation signal in response to the determined proximity to the given anatomical structure;
- receiving, by the warning device, the given activation signal; and
- generating, by the warning device, a given sensible output in response to the received activation signal.
- 2. The method according to aspect 1, wherein the warning device is detachable from the handle.
- 3. The method according to aspect 1, wherein the warning device comprises an illumination device or an audio generating device.
- 4. The method according to aspect 3, wherein the sensible output generated by the illumination device in response to the determined proximity to the given anatomical structure comprises light having different colors, different intensities, or different durations.
- 5. The method according to aspect 3, wherein the sensible output generated by the audio generating device in response to the determined proximity to the given anatomical structure comprises sounds having different tones, different frequencies, different volumes, different durations, different rates of recurrence or different synthesized words.
- 6. The method according aspect 1, and comprising presenting, on a display, the sensible output in response to the determined proximity to the given anatomical structure.
- 7. The method according to aspect 1, wherein the position sensor comprises a triaxial coil.
- 8. The method according to aspect 1, wherein the imaging system comprises a computed tomography scanner.
- 9. The method according to aspect 1, wherein the imaging system comprises an image coordinate system, wherein the position sensor comprises a sensor coordinate system, and comprising registering, prior to receiving the position signal indicative of a 3D blade location of the cutting blade within the body cavity, the sensor coordinate system to the image coordinate system.
- 10. The method according to aspect 1, wherein the medical probe comprises a motor mounted within the handle and configured to rotate the cutting blade at a plurality of rotation speeds, and comprising reducing the rotation speed of the cutting blade as the cutting blade approaches a given anatomical structure.
- 11. The method according to aspect 1, wherein the anatomical structures in the 3D image comprise different tissue radiodensities, and wherein determining a given 3D structure location comprises detecting the different radiodensities in the 3D image, segmenting, based on the detected different radiodensities, the 3D image into multiple segments, and determining respective 3D locations of the segments.
- 12. The method according to aspect 11, and comprising formulating an identification of a given segment of the multiple segments, and wherein the activation signal comprises the identification.
Claims (13)
- A medical apparatus, comprising:an insertion tube comprising a proximal end, and a distal end for insertion into a body cavity comprising one or more anatomical structures;a cutting blade mounted at the distal end of the insertion tube;a handle affixed to the proximal end and comprising a warning device which generates different sensible outputs in response to receiving different activation signals;a position sensor fixed in a predefined disposition relative to the insertion tube; anda processor configured:to acquire, from an imaging system, a three-dimensional (3D) image of the body cavity,to determine, in the 3D image, respective 3D structure locations for each of the one or more anatomical structures,to receive, from the position sensor, a position signal indicative of a 3D blade location of the cutting blade within the body cavity,to determine, based on the 3D blade location and the respective 3D structure locations, a proximity of the cutting blade to a given anatomical structure, andto convey, to the warning device, a given activation signal in response to the determined proximity to the given anatomical structure.
- The medical apparatus according to claim 1, wherein the warning device is detachable from the handle.
- The medical apparatus according to claim 1, wherein the warning device comprises an illumination device or an audio generating device.
- The medical apparatus according to claim 3, wherein the sensible output generated by the illumination device in response to the determined proximity to the given anatomical structure comprises light having different colors, different intensities, or different durations.
- The medical apparatus according to claim 3, wherein the sensible output generated by the audio generating device in response to the determined proximity to the given anatomical structure comprises sounds having different tones, different frequencies, different volumes, different durations, different rates of recurrence or different synthesized words.
- The medical apparatus according claim 1, and comprising a display, and wherein the processor is configured to present, on the display, the sensible output in response to the determined proximity to the given anatomical structure.
- The medical apparatus according to claim 1, wherein the position sensor comprises a triaxial coil.
- The medical apparatus according to claim 1, wherein the imaging system comprises a computed tomography scanner.
- The medical apparatus according to claim 1, wherein the imaging system comprises an image coordinate system, wherein the position sensor comprises a sensor coordinate system, and wherein prior to receiving the position signal indicative of a 3D blade location of the cutting blade within the body cavity, the processor is configured to register the sensor coordinate system to the image coordinate system.
- The medical apparatus according to claim 1, and comprising a motor mounted within the handle and configured to rotate the cutting blade at a plurality of rotation speeds, and wherein the processor is configured to reduce the rotation speed of the cutting blade as the cutting blade approaches a given anatomical structure.
- The medical apparatus according to claim 1, wherein the anatomical structures in the 3D image comprise different tissue radiodensities, and wherein the processor is configured to determine a given 3D structure location by detecting the different radiodensities in the 3D image, segmenting, based on the detected different radiodensities, the 3D image into multiple segments, and determining respective 3D locations of the segments.
- The medical apparatus according to claim 11, wherein the processor is configured to formulate an identification of a given segment of the multiple segments, and wherein the activation signal comprises the identification.
- A computer software product, operated in conjunction with a medical probe having an insertion tube and a position sensor fixed in a predefined disposition relative to the insertion tube, the product comprising a non-transitory computer-readable medium, in which program instructions are stored, which instructions, when read by a computer, cause the computer:to acquire, from an imaging system, a three-dimensional (3D) image of a body cavity comprising one or more anatomical structures;to determine, in the 3D image, respective 3D structure locations for each of the one or more anatomical structures;to receive, from the position sensor, a position signal indicative of a 3D location of a cutting blade mounted at a distal end of the insertion tube and inserted into the body cavity;to determine, based on the 3D blade location and the respective 3D structure locations, a proximity of the cutting blade to a given anatomical structure; andto convey, to a warning device mounted on a handle affixed to a proximal end of the insertion tube and configured to generate a plurality of sensible outputs in response to receiving a corresponding plurality of activation signals, a given activation signal in response to the determined proximity to the given anatomical structure.
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US20220378457A1 (en) * | 2021-05-25 | 2022-12-01 | Arthrex, Inc. | Dynamically controlling a distal window opening in a rotary surgical shaver |
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JP2019072479A (en) | 2019-05-16 |
AU2018236845A1 (en) | 2019-05-02 |
CA3019464A1 (en) | 2019-04-11 |
BR102018070861A2 (en) | 2019-05-07 |
KR20190040914A (en) | 2019-04-19 |
RU2018134955A3 (en) | 2022-02-21 |
US10813657B2 (en) | 2020-10-27 |
US20190105072A1 (en) | 2019-04-11 |
CN109646111A (en) | 2019-04-19 |
JP7221016B2 (en) | 2023-02-13 |
IL262112B (en) | 2021-05-31 |
IL262112A (en) | 2019-02-28 |
RU2018134955A (en) | 2020-04-06 |
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